MEDICARE: MISS KARLISTA PERALTA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	115539	TX

General Provider Information

NPI Number	:	1780751925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KARLISTA PERALTA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 5424
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77491-5424
Country	:	US
Telephone Number	:	917-650-1518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 DAIRY ASHFORD RD STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-3022
Country	:	US
Telephone Number	:	832-810-8132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/07/2025

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